Citation Nr: 0004748 Decision Date: 02/24/00 Archive Date: 02/28/00 DOCKET NO. 95-03 996 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Chicago, Illinois THE ISSUES 1. Entitlement to service connection for headaches. 2. Entitlement to service connection for dizziness. 3. Entitlement to service connection for poor circulation. 4. Entitlement to service connection for arthritis of the spine and shoulders. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARINGS ON APPEAL The veteran ATTORNEY FOR THE BOARD David S. Nelson, Associate Counsel INTRODUCTION The veteran had active military service from July 1943 to March 1946. This matter arises from a March 1993 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in Chicago, Illinois. This case was previously before the Board in February 1997 and was remanded for the purpose of affording the veteran a Travel Board hearing. FINDINGS OF FACT 1. There is no medical evidence of a nexus between the veteran's headaches and dizziness and his military service or any incident during such service. 2. There is no medical diagnosis of a current disability characterized as poor circulation. 3. There is no medical evidence of a nexus between the veteran's arthritis of the spine and shoulders, which was first shown many years after service, and any incident of active service. CONCLUSIONS OF LAW 1. The veteran's claim of entitlement to service connection for headaches is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 2. The veteran's claim of entitlement to service connection for dizziness is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 3. The veteran's claim of entitlement to service connection for poor circulation is not well grounded. 38 U.S.C.A. § 5107 (West 1991). 4. The veteran's claim of entitlement to service connection for arthritis of the spine and shoulders is not well grounded. 38 U.S.C.A. § 5107 (West 1991). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The law provides that a veteran is entitled to service connection for disability resulting from a disease or injury incurred or aggravated while in service. 38 U.S.C.A. § 1110; 38 C.F.R. § 3.303. Service connection for certain chronic disabilities, such as organic diseases of the nervous system and arthritis, will be presumed if manifest to a compensable degree within the year after service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307, 3.309. The Board must first determine whether the veteran has submitted well-grounded claims as required by 38 U.S.C.A. § 5107(a). To establish that a claim for service connection is well grounded, there must be a medical diagnosis of a current disability; evidence of inservice incurrence or aggravation of a disease or injury; and medical evidence of a nexus between the claimed inservice disease or injury and the present disease or injury. See Epps v. Gober, 126 F.3d 1464 (Fed. Cir. 1997). A claim may also be well grounded based on chronicity and continuity of symptomatology. 38 C.F.R. § 3.303(b); see also Savage v. Gober, 10 Vet. App. 488 (1997). A veteran is presumed to be in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities or disorders noted at the time of the examination, acceptance and enrollment for service. Clear and unmistakable evidence that the disability manifested in service existed before service will rebut the presumption. 38 U.S.C.A. § 1111. The Board notes that no physical abnormalities were noted on the veteran's July 1943 service induction physical examination. The veteran contends that during active service he fell off a truck and suffered an injury to his head that resulted in a loss of consciousness, headaches, and dizziness. He assets that he currently suffers from headaches, dizziness, poor circulation, and arthritis of the spine and shoulders as a result of the fall. Service medical records indicate that in October 1943 the veteran complained of dizziness and headaches. In November 1943 he was hospitalized for a period of observation after losing consciousness and suffering from generalized convulsions. The final diagnosis was vasomotor instability (a working diagnosis or impression of epilepsy was initially rendered, but was not confirmed in the veteran's remaining service medical records, including his service separation examination). The veteran further complained of headaches in January and February 1945. There are several references in the service medical records to headaches and dizziness and a head injury prior to service. There is nothing in the service medical records documenting an inservice head injury. The veteran's February 1946 service separation examination (neurologic portion) indicated that the veteran had suffered from dizziness in 1940 and 1943, and noted that there was presently "no disability." At a December 1992 VA examination (veins and arteries), the veteran stated that he had suffered from headaches since a 1943 service head injury. He indicated that he had headaches once or twice a week. He noticed dizziness when standing up and was unsteady when he walked to the bathroom at night. Under the impression the physician noted that the veteran had a history a history of a head injury with posttraumatic headaches but no other neurologic residual. VA medical records dated from January 1989 to November 1994 reflect ongoing treatment for complaints associated with dizziness. A June 1992 record notes that the veteran had mild dizziness secondary to a middle ear effusion. An August 1992 VA treatment record indicates a diagnosis of orthostatic dizziness. In February 1993, the veteran indicated that he had a dizzy spell that lasted 10 to 15 minutes. The VA physician stated that the veteran's dizziness might be due to "recent URI and bronchitis." An April 1993 record contained an assessment by an examiner stating that the veteran's dizziness was related to an autonomic dysfunction from diabetes mellitus. A March 1993 examiner remarked that the veteran's dizziness might be due to his cervical spine arthritis. A July 1993 record reflected an impression of dizziness, "multifactorial causes." At an October 1994 RO hearing, the veteran testified that he used to have just a few dizzy spells per year, but that they had increased in frequency in recent years. The veteran indicated that he had sought treatment for his dizziness and headaches from private physicians after service, but the physicians were now either dead or no longer able to be located. At the December 1999 Board hearing, the veteran indicated that his headaches and dizziness began after his head injury during service. The veteran stated that no physician had indicated to him that his headaches and dizziness were caused by his service injury. A. Headaches and dizziness The Board acknowledges that the veteran made complaints associated with dizziness and headaches during service, and further observes that current VA medical records reflect treatment associated with dizziness. However, a review of the record shows that there is no medical evidence linking the veteran's current complaints of dizziness and headaches to his military service or any incident during such service. The Board notes that, upon a VA vascular examination in December 1992, the physician noted that the veteran had a history of a head injury with post-traumatic headaches. However, aside from the fact that the veteran had headaches and a history of a head injury prior to service, and that the service medical records are negative for a head injury while on active duty, the examiner merely noted that the veteran had such a history; the "diagnosis" does not demonstrate that the physician, after listening to the patient's lay history and performing an examination, made a medical judgment based on both factors, that the appellant suffered a current condition attributed to the incident described in his history. See LeShore v. Brown, 8 Vet. App. 406 (1995). Moreover, subsequently dated medical records do not link any claimed current headache disorder to service. Further, there is no medical opinion relating his dizziness to any claimed continuity of symptomatology. Savage, supra. While the veteran has contended that he currently suffers from headaches and dizziness due to events during service, his contentions do not make his service connection claim well grounded. See Espiritu v. Derwinski, 2 Vet. App. 492, 495 (1995) (holding that laypersons are not competent to offer medical opinions on such matters as the diagnosis or causation of a disease or medical condition). The Board observes that VA examiners have rendered several opinions concerning the etiology of the veteran's dizziness problems; however, none of the opinions referenced the veteran's service injury or symptomatology manifested during his period of service. Further, though the veteran was admitted for observation during service in an effort to learn more about his headache and dizziness condition, the Board notes that no chronic headache or dizziness diagnosis was rendered, and no disability was found to exist on the veteran's service separation examination. As to the claim that the veteran's headaches and dizziness preexisted service but were aggravated therein, there is no medical opinion that supports a finding that there was a chronic worsening of either headaches or dizziness while on active duty. The Court has held that intermittent or temporary flare-ups during service of a preexisting injury or disease do not constitute aggravation. Rather, the underlying condition must have worsened. See Hunt v. Derwinski, 1 Vet. App. 292, 297 (1991). The medical evidence does not show that during service any preexisting underlying condition manifested by headaches or dizziness worsened. Hunt, supra; Jensen v. Brown, 4 Vet. App. 304 (1993). In support of this conclusion, the Board again notes that the veteran's separation examination was negative for any pertinent abnormal findings indicative of a disability manifested by headaches or dizziness at that time, and there is no post-service medical evidence of record relating to evaluation or treatment for headaches or dizziness until decades after service. The Board finds that, in the absence of any medical opinion supporting the contended aggravation and without medical evidence that shows a current diagnosis of headaches or dizziness linked to service, the veteran's claim is not well grounded whether it is based on a direct incurrence or aggravation basis. For these reasons, as the veteran has not submitted evidence a well grounded claim, his claim for service connection for dizziness and headaches must be denied on that basis. 38 U.S.C.A. § 5107(a). B. Poor circulation As the record stands, there is no competent medical evidence demonstrating that the veteran currently suffers from poor circulation. As the veteran has not presented any competent medical evidence that he currently suffers from poor circulation (i.e., he has not submitted evidence revealing a current diagnosis of poor circulation or a disability manifested by poor circulation), his claim for service connection for poor circulation is not well grounded and must be denied on that basis. 38 U.S.C.A. § 5107(a). C. Arthritis of the spine and shoulders Service medical records are negative for any treatment or complaints related to arthritis of the spine or shoulders. In May 1944 the veteran sought treatment for acute back strain incurred as a result of a sports injury. A December 1992 VA examination includes medical assessments of arthritis of the cervical spine and both shoulders, and the Board accepts these as medical diagnoses of current spine and shoulder disabilities for well-grounded purposes. Epps. The veteran has claimed that he began having problems with his spine and shoulders during service. The veteran's assertions with regard to his spine and shoulders during service are accepted as credible for well-grounded purposes. Epps. However, in the instant case, there is no medical evidence linking the veteran's arthritis of the spin and shoulders to service. It appears that any spine and shoulder problems experienced during service did not result in chronic disability. In this regard, the Board observes that clinical evaluation performed during the February 1946 service separation examination found the veteran's musculoskeletal system to be normal, and there is no medical evidence of record relating to post-service evaluation or treatment for spine or shoulder disabilities until decades after service. As the veteran has not presented any competent medical evidence that he currently suffers from arthritis of the spine and shoulders related to service, and as there is no medical evidence linking the continuity of symptomatology which the veteran claims to his current arthritis of the spine and shoulders, his claim for service connection for arthritis of the spine and shoulders is not well grounded and must be denied on that basis. 38 U.S.C.A. § 5107(a). See Savage, supra. The Board further notes that the veteran was not diagnosed with arthritis of the spine and shoulders until many years following service, and therefore the necessary link to service cannot be established through use of any statutory presumption. 38 U.S.C.A. §§ 1101, 1112 and 1137. D. Conclusion The Board is aware of no circumstances in this matter which would put VA on notice that relevant evidence may exist or could be obtained, which, if true, would make the claims for service connection "plausible." See generally McKnight v. Gober, 131 F.3d 1483 (Fed. Cir. 1997). By this decision, the Board is informing the veteran that his service connection claims require a medical diagnosis of current disability as well as medical evidence of a nexus to service to meet the requirements of a well-grounded claim. See 38 U.S.C.A. § 5103(a) (West 1991); Robinette v. Brown, 8 Vet. App. 69 (1995). ORDER Evidence of a well-grounded claim not having been submitted, entitlement to service connection for headaches is denied. Evidence of a well-grounded claim not having been submitted, entitlement to service connection for dizziness is denied. Evidence of a well-grounded claim not having been submitted, entitlement to service connection for poor circulation is denied. Evidence of a well-grounded claim not having been submitted, entitlement to service connection for arthritis of the spine and shoulders is denied. R. F. WILLIAMS Member, Board of Veterans' Appeals